Provider Demographics
NPI:1851865075
Name:MEDEIROS, JAN
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PARK AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2276
Mailing Address - Country:US
Mailing Address - Phone:508-633-4886
Mailing Address - Fax:
Practice Address - Street 1:112 PARK AVE APT 3
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2276
Practice Address - Country:US
Practice Address - Phone:508-633-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician